Introduction

Scientifically, retinopathy of prematurity (ROP) also known as the terry syndrome or retrolental fibroplasia (RLF) is a disease that affects human eyes. Basically, this disease occurs in infants who are premature and may end being born blind as a result. Science has identified that the disease mostly occurs during the fetal development, it during the process, it is biologically normal that the blood vessels surrounding the eyes grow outwards and become fully grown after a full gestation period (Stahl et al.,2016).However, when infants are born before their due time or through premature birth, the blood vessels become scarred or damaged, or they abnormally grow in the retina of aninfant thus causing the terry syndrome(AARC website). Even though the disease may either be a mild one, in most cases, it leads to blindness in premature infants.

Pathophysiology

Biologically, it is evident that commonly prematurity/preterm occurs as a result of both the mother and the infant being in extremely low birth weight abbreviated as ELBW. Further scientific researches basically do place reliance on many factors that result in low birthweight infants. Such factors include a chronic or severe illness that may range from sepsis conditions, bronchopulmonary dysplasia and in some cases the conditions caused by respiratory distress syndrome otherwise known as RD (Hartnett, 2015). Notably, these conditions when in severe levels place the immature infant at higher risk of suffering the terry syndrome.

During the gestational period, around the 16^th week, it is worth noting that this is the time when the Retinal vasculature begins to grow, this growth, proceeds with the gestation process until the full term. The rationale, therefore, is that whena premature birth occurs, the growth of the retinal vasculature ceases to grow or to mature as required(Cayabyab and Ramanathan,2016).Usually, as a medication for the preterm birth, hospital facilities provide generally oxygen for the infants in the nursery, the exposure of the infants to artificial oxygen (hyperoxia)negatively affects the retinal vascular endothelial growth factor. As a result, it is observable that the surrounding vessels around the retina not yet fully grown begin to constrict or undergo obliteration and thus fails to develop normally in a process referred to as hyperoxia-vasocessation(Kychenthal et al. 2017).Basically, the delayed development of retinal vascular is referred to as stage 1 of terry syndrome.

As the retina continues to receive more hyperoxia and more oxygen nutrients through a diffusion process, it continues to increase in thickness, and with time, it outgrows the required vascular supply that causes hypoxia-vasoproliferation. Science indicates that this is stage 2 of the ROP disease, notably, at this stage, the abnormal growth of the vessel is progressing gradually. In the same breath, stage III occurs after the vessel growth is full, the vessel spread on to the vitreous in the eyes and may at times cause fluid leakage and scarring(AARC website). When retinopathy of prematurity hits stage IV it is evident that the enlarged vessel will be partially detached from the retina thus causing more harm and it is at the last stage otherwise referred to as stage V when a complete detachment from the retina occurs(Cayabyab and Ramanathan, 2016). Summarily, infants born between the preterm of 20 to 30 weeks and extreme below birth weight usually develop the ROP disease of any stage and are severely affected when they suffer other related disorders.

Signs and Symptoms

Generally, as earlier mentioned in the above sections, it is evident that a number of factors contribute to the occurrence of retinopathy of prematurity disease such risk factors include, the low birth weight, cardiac defects and infections, extreme exposure to oxygen and related substances and prematurity which creates an avenue for terry syndrome to develop easily (Young and Fallas, 2016).In these circumstances, research has equally indicated that since retinopathy of prematurity usually occurs deep inside the infant’s eyes, signs and symptoms are not easy to detect by simple observation(AARC website).In this regard, therefore, to identify such signs and symptoms, an ophthalmologist or any doctor with special eye care skills is thus tasked to be able to detect the presence of retinopathy by examining the infant’s retina in a process referred to as screening.

Fundamentally, some of the identifiable signs and symptoms of retinopathy of prematurity in infants includecomplications that may be visibly seen after a screening of the retina. These complications in an infant include the unusual or abnormal movements of the eyes referred to as nystagmus. Medication has to be immediately recommended when a doctor detects abnormal eye movements. Secondly, by clinical examination I the eyes of the infant, a doctor will be able to note the whiteningof the infant’s pupils, this is a condition referred to as leukocoria. The presence of white pupils is a clear sign and symptoms that the infant is suffering from retinopathy(Young and Fallas, 2016). However, such observation may be noted by anyone, and when identified even if it is in a single eye, it is recommendable to call on an ophthalmologist instantly to avoid serious effects that may lead to blindness.

On the other hand, some infants may readily indicate the unusual appearance of blood vessels in the eyes. Such symptoms are a clear indication that the retinopathy is in progression. The blood vessels appear as a result of the rapid abnormal growth, dilation and twisting of the vessels which make them appear on the outer surface especiallyaround the pupil or iris. Another sign and symptoms are detected by the rigidity of the infant’s pupil, where it does not easily dilate or move freely. In the same breath, an ophthalmologist will be able to detect the haziness in the vitreous humor of the infant as among the signs and symptoms of retinopathy(Young and Fallas, 2016). To some infants, the lens of the eyes referred to as cataracts may lose transparency while others may equally experience inflammations and abnormally sunken eyes and also experience visual loss.

Diagnostics

With reference to the above sections, it is worth noting that all premature infants face the risk of being affected by the risks posed by the Retinopathy(Liegl et al. 2016).This being the case, all preterm infants ought to be thoroughly examined by the healthcare providers or doctors from when they are born to the period recommended for any signs and symptoms of retinopathy. Re-examination should be done up to when the growth of blood vessels is determined to be fully grown to ensure that the infants are free from the infection and when affected, be placed on medication.

Medically, it is evident that doctors will employ the use of eye drops whose purpose is to dilate the pupils in each eye. The rationale is that a dilated pupil is easy to examine by having a clear view of the retina, blood vessels, vitreous humor and the optic nerves with the aid of ophthalmoscope instrument.  The instrument helps detect the signs of retinopathy place the infant on surveillance or recommend treatment/intervention strategy. Fundamentally, where serious symptoms such as scarring are detected, medially an ophthalmologist will recommend that the infant is placed on a regular program for monitoring(AARC website).This program should last a lifetime to be able to detect in time, offer treatment and prevent further progression or development of related conditions such as glaucoma, refractive errors, retinal detachment or amblyopia conditions.

Treatment

Medical researchers have indicated that treatment may be conducted through a process referred to as peripheral retinal ablation. Treatment involves a team including the ophthalmologist, pediatricians and even neonatologists among other professionals to stage an effective treatment. It is also recommendable that treatment is done before the retina is detached or otherwise treatment will be more complex(Stahl et al. 2016). Basically, an ophthalmologist will identify areas of the retina and freeze it through cryotherapy process or use a direct beam of light called laser therapy to the eye. These processes will prevent the proliferation or reverse the growth of the retinal vessels/detachment. Further medical research by Sankar et al. 2018 also indicated that injections such as anti-vascular endothelial growth factor referred to as VEGF in the form of pharmacological therapy equally help treat retinopathy disease.

Incases where the retinopathy has become severe and complex, doctors opt to conduct the correctional or incisional surgical repair. The repairs are basically to reattach the detached retina through a process referred to as scleral buckling. Apart from this surgical method of treatment, an ophthalmologist may also recommend additional treatment or intervention strategies because surgery may not always solve the problem(Stahl et al. 2016).Such interventions measures include the victim using corrective glasses and the general re-examination and monitoring to alleviate the retinopathy conditions.

Mortality and Morbidity

Research indicates that preterm infants suffer retinothapy and a more significant percentage of them are at a higher risk of mortality. However, it is noteworthy that despite the presence of treatment or intervention, it is notable that when the victims survive, they become handicaps. In the same breath, retinopathy poses long term impacts, for instance, some of this outcomes include the victims or preterm infants suffering conditions such as visual Impairment that is severe, while some suffer blindness(Beltempo et al. 2018). On the other hand, some victims suffer amblyopia, myopia and a conditionreferred to as strabismus. Summarily, without clear and early ophthalmological intervention by a qualified professional, the resulting impact is blindness.

Prognosis Presentation

According to medical discoveries indicate that even though retinopathy causes ultimate blindness, both stages I and II do not necessarily cause loss of eyesight. However, it is worth noting that retinopathy may progress to stage II and 1V which are more severe to cause blindness. Research also indicates that every retinopathy detected, has a higher percentage (approximately 50%) of progressing to further stage, that is, the retinal detachment which is the threshold for the condition. Stage IV indicates a progression of the disease referred to as partial detachment while the final stage which results to total blindness or loss of sight is referred to as the complete retinal detachment(Coats and Olitsky, 2017).The figures below indicate the process from stage I of retinopathy of prematurity.

The figure above shows whathappens in retinopathy or prematurity, basically the condition causes the abnormal development of the blood vessels in the eye, they tend to swell or leak blood, therefore, causingscarring in the retina which causes blurred or blocked vision.

When the scarring finally shrinks as indicated in the diagrambelow, the vessel detaches from the retina which thus results in total blindness.

During extreme retinopathy of prematurity, there is usually an advanced stage of retinal detachment treatment, in this case, is achieved through scleral buckling as shown in the diagram below. The ophthalmologist usually uses a flexibleband placed in the eyes’ circumference and around the sclera forcing it to be pushed inwards through a process referred to as buckling. The place band thus pushes the detached retina closer and back to the wall of the eye to function normally.

Reference

AARC: American Association for Respiratory Care http://www.aarc.org/

Beltempo, M., Shah, P. S., Ye, X. Y., Afifi, J., Lee, S., McMillan, D. D., & Canadian Neonatal Network Investigators.(2018). SNAP-II for prediction of mortality and morbidity in extremely preterm infants. The Journal of Maternal-Fetal & Neonatal Medicine, 1-8.

Cayabyab, R., &Ramanathan, R. (2016). Retinopathy of prematurity: therapeutic strategies based on pathophysiology. Neonatology, 109(4), 369-376.

Coats, D. K., &Olitsky, S. E. (2017). Retinopathy of prematurity: Treatment and prognosis. UpToDate, Waltham, MA.

Hartnett, M. E. (2015). Pathophysiology and mechanisms of severe retinopathy of prematurity. Ophthalmology, 122(1), 200-210.

Kychenthal, B. A., Dorta, S. P., &Kychenthal, B. A. (2017).Retinopathy of Prematurity.Springer.

Liegl, R., Hellström, A., & Smith, L. E. (2016). Retinopathy of prematurity: the need for prevention. Eye and brain, 8, 91.

Sankar, M. J., Sankar, J., & Chandra, P. (2018). Anti‐vascular endothelial growth factor (VEGF) drugs for the treatment of retinopathy of prematurity. Cochrane Database of Systematic Reviews, (1).

Stahl, A., Hellström, A., & Smith, L. E. (2016).Retinopathy of Prematurity.In Anti-Angiogenic Therapy in Ophthalmology (pp. 21-29).Springer, Cham.

Young, R. C., &Fallas, B. J. (2016).Retinopathy of prematurity.In Manual of Retinal Diseases (pp. 51-55).Springer, Cham.